Developing a real-time electronic symptom monitoring system for patients after discharge following cancer-related surgery

BMC Cancer

Ruth Harding¹  Trudy Reed¹  Elaine O’Connell Francischetto²  Amanda Portal³  Hollie S. Richards⁴  Kerry N. L. Avery⁴  Jane M. Blazeby⁵  Kate Absolom⁶  Galina Velikova⁶  Leon Bamforth⁶  Robert Carter⁶ 

[1] 0000 0004 0380 7336, grid.410421.2, Division of Surgery, University Hospitals Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK;0000 0004 1936 7486, grid.6572.6, NIHR CLAHRC West Midlands Chronic Disease Theme, Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK;0000 0004 1936 7603, grid.5337.2, Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, BS8 2PS, Bristol, UK;0000 0004 1936 7603, grid.5337.2, Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, BS8 2PS, Bristol, UK;0000 0004 1936 7603, grid.5337.2, Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, BS8 2PS, Bristol, UK;0000 0004 0380 7336, grid.410421.2, Division of Surgery, University Hospitals Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK;Section of Patient-Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James’s, University of Leeds, St James’s Hospital, LS9 7TF, Leeds, UK;

关键词: Adverse effects;    Patient-reported outcome measures;    Electronic;    Electronic health records;    Internet;    Neoplasms;    Operative;    Outcome assessment, patient;    Self-management;    Surgical procedures;   

DOI  :  10.1186/s12885-019-5657-6

来源: publisher

【 摘 要 】

BackgroundPatients undergoing major cancer surgery frequently require post-acute care for complications and adverse effects. Enhanced recovery after surgery programmes mean that patients are increasingly discharged home earlier. Symptom/complication detection post-discharge is sub-optimal. Systematic patient monitoring post-discharge following surgery may be optimally achieved through routine electronic patient-reported outcome (ePRO) data capture. ePRO systems that employ clinical algorithms to guide management of patients and automatically alert clinicians of clinically-concerning symptoms can improve patient outcomes and decrease hospital admissions. ePRO systems that provide individually-tailored self-management advice and integrate live ePRO data into electronic health records (EHR) may also advance personalised health and patient-centred care. This study aims to develop a hospital EHR-integrated ePRO system to improve detection and management of complications post-discharge following cancer-related surgery.MethodsThe ePRO system was developed in two phases: (1) Development of a web-based ePRO symptom-report from validated European Organisation for Research and Treatment of Cancer (EORTC) questionnaires, clinical opinion and patient interviews, followed by hospital EHR integration; (2) Development of clinical algorithms triggering symptom severity-dependent patient advice and clinician alerts from: (i) prospectively-collected patient-completed ePRO symptom-report data; (ii) stakeholder meetings; (iii) patient interviews. Patient advice was developed from: (i) clinician-patient telephone consultations and patient interviews; (ii) review of hospital patient information leaflets (PIL) and patient support websites.ResultsPhase 1, including interviews with 18 patients, identified 35 symptom-report items. In phase 2, 130/300 (43%) screened patients were eligible. 61 (47%) consented to participate and 59 (97%) provided 444 complete self-reports. Stakeholder meetings (9 clinicians, 1 patient/public representative) and patient interviews (n = 66) refined advice/alert accuracy. 15 telephone consultations, 7 patient interviews and review of 28 PILs and 3 patient support websites identified 4 themes to inform self-management advice. Comparisons between ePRO symptom-report data, telephone consultations and clinical events/outcomes (n = 27 patients) further refined clinical algorithms.ConclusionsA hospital EHR-integrated ePRO system that alerts clinicians and provides patient self-management advice has been developed to improve the detection and management of problems and complications after discharge following surgery. An ongoing pilot study will inform a multicentre randomised trial to evaluate the effectiveness of the ePRO system compared to usual care.

【 授权许可】

CC BY